DESCRIPTION: The proposed study explores the experience of end stage renal disease (ESRD) patients as they readapt to dialysis for a second time. Findings will enhance nursing knowledge of the concerns or burdens of patients with this chronic illness, and will provide new information for future development and testing of nursing interventions, which will influence patient health outcomes. In the U.S., nearly 79,000 patients enter dialysis therapy annually. An important nursing outcome for these patients is a positive adaptation to the necessity for dialysis dependence. The only ways to avoid dialysis are through kidney transplantation or death. At least 1/4 will lose the transplanted kidney within 3 years, requiring them to again become dependent on dialysis to survive. An additional group of ESRD patients experiencing 'loss' of a transplant has been identified from persons notified to come to the hospital 'as the back up candidate' for a potential transplant. They also must return to dialysis once the organ has been given to someone else. The specific aims are: 1) describe the meaning of the experience of readaptation to ESRD patients who return to dialysis, 2) describe any changes in the meaning of the experience for ESRD patients at specific times over the first year of returning to dialysis, 3) describe how the meaning of the experience for two different groups of ESRD patients are similar or different, and 4) describe the patients' perceptions of nurses' actions as they experience "loss" of a kidney transplant and readaptation to dialysis. Audiotaped interviews (1, 4, 8 and 12 months) will be transcribed verbatim and analyzed by hermeneutic analysis techniques. In this 7-stage procedure: a) themes within and b) patterns across narratives will be identified. A computerized qualitative research program will be used to assist with data management. Findings will be useful in future research in nursing interventions for assisting readaptation to dialysis.